What is Double Mastectomy ?

Mastectomy is a surgical procedure applied in removing one or both breasts either partially or completely. Mastectomy is a broader term used to describe a number of surgical procedures applied to remove the breast. The term can be used to describe a surgery for removing one or both breast as well as removing lymph bones in the armpit area in order to detect any possible spread of cancer. Double mastectomy entails the removal of both breasts. There are different types of mastectomy and they include modified radical mastectomy, which involves removing the entire breast together with the skin, breast tissue, nipple, and areola. Sometimes, the chest muscle lining and some other tissues on the chest may also be removed.

Modified radical mastectomy procedure may also entail removal of underarm lymph nodes in what is known as complete axillary node dissection where numerous lymph nodes are removed. A simple or total mastectomy is done to remove the entire breast and surrounding tissue such as the skin, nipple, and areola. In addition, a sentinel lymph node biopsy could also be removed whereby only the first one or two lymph nodes in the armpit are removed.

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Another type of mastectomy is skin-sparing mastectomy, which removes the breast tissue, areola, and nipple but leaves the skin of the breast. A breast reconstruction is done immediately after this procedure. However, this procedure is not suitable for large tumors. Nipple-sparing or subcutaneous mastectomy removes the breast tissue but leaves the skin, nipple, and areola and a breast cosmetic reconstruction is performed.

When is mastectomy recommended?

This procedure may be recommended if breast cancer tumours are widespread and if other treatment options are not viable. If you have two or more cancer tumors in the breast areas or there is prevalent or malignant-appearing calcium known as microcalcifications in breast, and which have been detected as cancer through biopsy, then mastectomy procedure may be applied.

In addition, if a patient has previously had a radiation therapy at the breast and there is a recurrence of cancer, then a mastectomy is applied. Risks associated with radiation therapy may necessitate the use of mastectomy therapy in cancer treatment. If you have previously had lumpectomy (a breast-conserving surgery) but the cancer is still presenting at the margins of the breast area, you may need mastectomy to be carried out.

People who carry a gene mutation that may present a higher risk of development of cancer may also require mastectomy. Large tumors that are bigger than the overall size of the breast could imply that if other surgery procedures like lumpectomy are performed, they may not allow enough healthy tissue left for a reconstructive surgery result to be achieved.

Some connective tissue disease like lupus and scleroderma may not be able to tolerate side effects of radiation therapy on the skin, something that would necessitate mastectomy to be performed. Finally yet importantly, this procedure is applied if a patient does not have access to radiation facility.

Mastectomy for breast cancer prevention

Although this procedure may be performed to remove breast cancer tumors, it may also be applied to prevent the cancer from occurring in the first place. A person may consider mastectomy even without a breast cancer where there is a high risk of developing cancer tumors. Prophylactic mastectomy is a risk-reducing surgical produce against the growth of cancer of the breast and it can minimize the possible development of the cancer in future.

This procedure is reserved for people who have genetic mutations, which increase the risk of suffering breast cancer. It is also recommended in people who have a strong family history of developing the disease. Therefore, not all people may be good candidate for prophylactic mastectomy.

A good example is the Angelina Jolie’s double mastectomy surgery whereby she took a decisive choice to have her breasts removed after she was tested and found to have BRCA gene mutation, which is associated with high risk of developing breast cancer. Information from the American Cancer Society reveals that cases such as that of Jolie are rare but they present real threats in suffering breast cancer.

It is estimated that of the breast cancer cases, only about 5 percent are likely to arise from faulty BRCA gene. Although not every woman needs to be tested of BRCA gene mutation and that not every women who tests positive of BRCA gene mutation may be required to undergo double mastectomy, there are factors which should be examined to determine if a women should be tested of the gene mutation such as a strong family history of developing cancer.

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As for the case of Angelina Jolie, she lost her mother and aunt of the same disease. This was a convincing reason to have her tested of BRCA gene mutation and her decision might have been correct. The aspect of testing for BRCA gene mutation may need to be further elaborated because it may lead to the wrong perception about cancer development. If a woman tested negative of BRCA gene mutation, it could lead to a false reassurance that one is not susceptible to developing cancer. Therefore, other factors need to be looked at not just the gene mutation and the subsequent test results.

Cost of Double Mastectomy, does health insurance cover it ?

The cost of double mastectomy is more than $50000 and health insurance does not cover it, generally.  It is not deemed as a medical necessity and a consensus is due. Just to diagnose if a woman may have genes that can cause breast cancer, costs $4000. Plus, there are costs of breast reconstruction surgery and hospital fees.  Surgical complications are not ruled out and that can increase the overall medical bill.


Angelina Jolie Double Mastectomy Pictures


Angelina Jolie announcing her double mastectomy in the New York Times blog

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